Health Care Reform

 

The following is a summary of the law and an abridged timeline for enactment of Healthcare Reform.
For more detailed information please feel free to visit www.hhs.gov/healthcare or the Health Reform Source, provided by the Henry J. Kaiser Family Foundation ©.
 
 
 
July 1, 2010-
Pre-Existing Condition Insurance Plan (PCIP) becomes effective
 
 
September 23, 2010-
No pre-existing condition exclusions for children (To age 19)
 
Extension of Dependent coverage to age 26
 
Elimination of Rescissions
 
No discrimination in favor of highly compensated members
 
Reinsurance required for early retirees
 
Medical Loss Ratio Reporting begins
 
Updates to Internal and External Appeal Processes
 
Required Access to OB/GYN without a referral or prior authorization
 
Choice of Primary Care Provider
 
Out-of-Network Emergency Services must be covered as In-Network
 
Restricted Annual Dollar Limits for Essential Benefits
 
No Lifetime Maximum Limits for Essential Benefits
 
Preventive services must be covered with no cost-sharing
 
Coverage cost-sharing transparency and disclosure requirements enacted
 
Small Business Tax Credit – The First Phase
 
October 2010-
Establishment of Consumer Assistance Programs in States
 
 
 
January 1, 2011-
Prescription Drug Discounts required for Medicare Part D members
 
Preventive Coverage expanded for Medicare Members
 
Improvements to health care quality and efficiency implemented
 
Medical Loss Ratio Rebates are required by insurance carriers
 
Strengthening of Medicare Advantage Plans
 
 
January 1, 2013-

Further Improvement of Preventive Health Coverage - In an effort to increase the number of Americans receiving preventive care, the law grants new funding to state Medicaid programs that choose to cover preventive services for patients at little or no cost.

Expanded Authority to Encourage “Bundling” Payments - With payment “bundling,” hospitals, doctors, and providers are paid a flat rate for an episode of care rather than the current fragmented system where each service or test or bundles of items or services, are billed separately to Medicare.

Increased Medicare Payments to Primary Care Physicians - Fully funded by the federal government, the Act requires states to pay primary care physicians no less than 100% of Medicare payment rates in 2013 and 2014 for primary care services

 

October 1, 2013-

Additional Funding for the Children’s Health Insurance Program (CHIP) -  Under the law, states will receive two more years of funding to continue coverage for children not eligible for Medicaid

 

January 1, 2014-

Increased Access to Medicaid
 
Guaranteed Availability of Health Insurance - Strong reform is implemented to forbid insurance companies from refusing to sell coverage or renew policies due to any individual’s pre-existing conditions. Furthermore, in the small group and individual market, insurers are prohibited from charging higher rates due to gender or health status. 
 
Elimination of Annual Limits on Insurance Coverage - New and existing group plans are prohibited from imposing annual dollar limits on the amount of coverage an individual may receive.
 
Coverage required for Individuals Participating in Clinical Trials - Insured individuals can no longer be dropped nor have limitations placed on their coverage because they choose to participate in a clinical trial. This provision applies to all clinical trials that treat cancer or other life-threatening diseases
 
Creation of Essential Health Benefits - This package, that provides a comprehensive set of services, covers at least 60% of the actuarial value of the covered benefit and limits annual cost-sharing to the current Health Savings Account (HSA) limits ($5,950/individual and $11,900/family in 2010). It also creates four categories of plans to be offered through the Exchanges, and in the individual and small group markets, requiring they offer at least the essential health benefits package.

Healthcare Coverage must be more Affordable - Tax credits are implemented for people with incomes between 100% and 400% of the poverty line, who are not eligible for other affordable coverage. The credit will be advanceable, making it possible to lower premium payments each month, rather than waiting for tax filing time. Additionally, it is refundable, so even moderate-income families can receive the full benefit of the credit.

Implementation of Individual Mandate and Promotion of Responsibility - This provision requires those individuals who can afford it, to obtain qualifying health coverage or pay a fee to help offset the costs of caring for uninsured Americans. In the event affordable coverage is not available, some individuals may become eligible for an exemption.
  
 
Small Business Tax Credit – The Second Phase - In this phase, the credit is increased up to 50% of the employer’s contribution to provide health insurance for employees. Small non-profit organizations can receive up to a 35% tax credit.

Establishment of Exchanges and the Health Insurance Marketplace - The law creates State-based American Health Benefit Exchanges and Small Business Health Options Program (SHOP) Exchanges, administered by a governmental agency or non-profit organization, through which individuals and small businesses with up to 100 employees can purchase qualified coverage. Exchanges will have a single form for applying for health programs, including coverage through the Exchanges and Medicaid and CHIP programs.Additionally, if an employer does not offer insurance, individuals will be able to purchase a qualified health benefits plan directly from the Health Insurance Marketplace.

 

 2015-

Increase Federal Match for CHIP

Implementation of the Employer Mandate and Employer Voucher (DELAYED TIL 2015)- Under the law, a fee of $2,000 per full-time employee (excluding the first 30 employees, on employers with more than 50 employees) will be assessed, when they do not offer coverage and have at least one full-time employee who receives a premium tax credit. Employers with 51+ employees that offer coverage but have at least one full-time employee receiving a premium tax credit, will pay the lesser of $3,000 for each employee receiving a premium credit or $2,000 for each full-time employee (excluding the first 30 employees)

 

 2018-

Tax imposed on High-Cost Insurance - This provision will impose an excise tax on insurers of employer-sponsored health plans with aggregate expenses that exceed $10,200 for individual coverage and $27,500 for family coverage.

 
The information provided above is merely summarized and based on current legislation, and is subject to change. For the most up-to-date health care reform guidelines visit www.hhs.gov/healthcare or check out any of the following websites: